Title Page

  • Prepared by

  • Conducted on

  • Site

  • Floor

  • Occupier Name

  • Location
  • FCU ID

FCU

FCU Information

  • FCU Make

  • FCU Model

  • FCU Serial Number

  • EC Fan Fitted

  • Photo of unit

Controller

Controller Information

  • Controller Make

  • Controller Model

Valves and Actuators

Valves and Actuators

  • LTHW and CHW Valves Make

  • LTHW and CHW Vales Model

  • Photo of both valves

  • Actuator Make

  • Actuator Model

  • Actuators Fitted correctly

Flow

  • CHW Design Flow l/s (Kvs)

  • CHW Recorded Flow l/s (Kpa)

  • LTHW Design Flow l/s (Kvs)

  • LTHW Recorded Flor l/s (Kpa)

Air

Air Load

  • Number of Air Outlets

  • Condition of air Grilles

  • Details

  • Details

Air Supply

  • FCU Filters

  • Filters Cleaned

  • Filter Cleaned

History

Historic Issues

  • Has any issues been noted in the last 3 months?

  • Provide Help Desk Details

  • Other notes or concerns

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.